Report Calls For Policy Changes In Response To Dependence and Withdrawal From Prescribed Drugs

Justin Karter
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Statistics from the UK reveal that prescriptions for painkillers and antidepressants continue to rise despite concerns over dependence and debilitating withdrawal effects. The British Medical Association (BMA) Board of Science has released a report that acknowledges changes to medical practice, research and policy necessary for addressing the dependence and withdrawal effects of benzodiazepines, opioids, and antidepressants.

The Board of Science conducted a review of the issue Prescribed drugs associated with dependence and withdrawal – building a consensus—by soliciting evidence on dependence and withdrawal from governmental, support and charitable organizations.

The researchers collected all of the responses submitted from the various agencies and analyzed it for common themes and overarching patterns.  The analysis revealed seven themes, which touched on the following issues:

 

Managing benzodiazepine dependence and withdrawal in general practice

It was reported that many general practitioners use a rapid tapering or “cold turkey” strategy to manage prescription benzodiazepine dependence and that these practices often force patients into support groups and withdrawal charities.  Rapid tapering, according to the support groups, is often associated with the worst cases of withdrawal and it appears that general practitioners often underestimate the effects of the dependency and “impose unrealistic time scales on the pareing process.” Seventy-one percent of respondents reported feeling unsupported by their doctor after the dependency was acknowledged.  In response, the report suggests that new guidelines should emphasize that “the rate of withdrawal tapering should be gradual and flexible around the patient.’ 

A subtheme identified for this issue draws attention to the long-term prescribing of benzodiazepines against clinical guidelines.  Current guidelines suggest that benzodiazepines be used for only 2-4 weeks, including the tapering period, but many of the organizations reported that these parameters are rarely followed.  The lack of funding and attention given to non-pharmacologic treatments and therapies was cited as one reason that many patients may end up taking the drugs over the long-term.

 

Governance and service provision for patients suffering with prescription drug dependence and withdrawal

Nearly all responses indicated a gap in care for those who have become addicted to prescription drugs, according to the report.  The support organizations claim that existing drug rehabilitation and withdrawal services that are designed for illegal drug use are not adequately trained or resourced to provide the services necessary for this patient group.  The responses also criticized reliance on volunteer and private organizations to fill this gap and care.

 

Harms associated with prescription benzodiazepine dependence and withdrawal

Withdrawal charities, support groups and individuals affected by benzodiazepines reported a number of potential harms from the benzodiazepine use, including: “physical (seizures, headaches, palpitations), psychiatric (hallucinations, psychotic episodes, anxiety, panic attacks, suicidal intention), psychological (trauma) and social harms (loss of job, leave education, financial instability).”

In addition, research submitted by Catherine Pittman revealed that the length of recovery from dependence may be longer than previously recognized.  Her study found “96 percent of long-term prescribed users continued to experience withdrawal symptoms for an average of 14 months after withdrawal and cessation from benzodiazepines.”  There was also an indication that there may be enduring symptoms such as tinnitus, anxiety, motor symptoms, gastrointestinal issues, and paresthesia (a pricking sensation caused by nerve damage).

 

Attitudes towards the cause of prescription drug dependence and withdrawal

The report acknowledges a noticeable difference of opinion about that causes of prescription drug dependence between the governmental and practitioner organizations on one side and the support groups, withdrawal charities, and affected individuals on the other. The first group attributed patterns of dependence to individual differences in patients while the latter placed accountability on the inappropriate prescribing practices of the doctors.  Research submitted by Pittman appears to substantiate the claims of the second group.  The report states:

“Her research found no difference in the emergence and experience of withdrawal symptoms between those individuals prescribed benzodiazepines for psychiatric versus non-psychiatric (e.g., seizures, muscle tension, recovery from surgery) conditions. This suggests that long-term exposure to benzodiazepines per se may account for the severity of withdrawal experienced by prescribed users, and subsequently difficulties terminating use, rather than pre-existing individual differences in mental health status.”

The support groups, charities, and individual also indicate increased stigma from medical professionals after a patient becomes dependent on the drugs prescribed to them.

 

Research and data on prescription drug dependency and withdrawal

Many respondents pointed to the lack of research being done on prescription drug dependence with benzodiazepines, analgesics, antidepressants and Z-drugs.  In addition to research on the drug effects, more work needs to be done to develop best practices and clinical guidelines for first identifying dependence and then deciding on the most advantageous course of action.

 

Opioids prescribed for chronic non-cancer pain

There are concerns about the increased use of opioids for chronic pain.  The withdrawal symptoms from dependence on these drugs were recognized to be severe and potentially disabling. “Despite widespread prescribing, the safety and efficacy of long-term prescribed opioids for chronic non-cancer pain was reported to be unknown.”  Similar to benzodiazepine prescriptions, responses again noted that while there are existing guidelines for opioid prescribing that they are not always followed and that more work needs to be done to understand why these practices are occurring.

 

Antidepressants

There was a widespread concern that antidepressants are being prescribed without a clinical need and that they may be unsafe and also cause dependence and withdrawal symptoms after long-term use.  Respondents pointed to the research evidence that suggests that the drugs may be ineffective for mild and moderate depression and that their benefits are unclear even in cases of severe depression.  Charity and support groups reported that antidepressants may cause severe mood disturbances, suicidality, and, potentially, dependence, but practitioners reported the long-term benefits and relative safety of antidepressants.  For those that acknowledged the potential withdrawal effects of coming off of antidepressants, there was also agreement that there is no well researched or recognized approach for managing antidepressant withdrawal.

 

Read The Full BMA Report →

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Justin Karter
MIA Research News Editor: Justin Karter is a writer, researcher and community organizer with graduate degrees in both journalism and community psychology. He is a doctoral candidate in Counseling Psychology at UMass Boston, an active member of the Society for Humanistic Psychology, and is currently working on several scholarly projects at the intersection of psychology, social theory, and political philosophy.

12 COMMENTS

  1. The states settled their Medicaid lawsuits against the tobacco industry for recovery of their tobacco-related health-care costs…

    The general theory of these lawsuits was that the cigarettes produced by the tobacco industry contributed to health problems among the population, which in turn resulted in significant costs to the states’ public health systems. As Moore declared, ” the lawsuit is premised on a simple notion: you caused the health crisis; you pay for it. ”

    They should do a similar thing to these drug makers and doctors: you caused the health crisis; you pay for it.

  2. I have campaigned in the UK for 30 years in order for our government and the doctors to accept responsibility and accountability for this massive public health scandal.
    We need dedicated withdrawal services and after care facilities for those prescribed drug addicts who want to try and recover from their medically induced addiction.
    We need a countrywide set up of peer support groups.
    We need a 24 hour helpline.
    We need to educate the doctors, psychiatrists and governments on the true dangers of prescribed drug addiction.
    We need a 20% annual tax on the pharmaceutical industries annual turnover to fund the mess and suffering their drugs have caused to patients and society. Pay back time.
    We need a national and international framework of best practice, both in prescribing and withdrawal schedules.
    We need to stop new patients from becoming addicts by making guidelines mandatory on doctors and psychiatrists, in fact ALL prescribers.
    We need the State to recognise the harm done by these drugs and to fund independent research into the long term damage that is caused by iatrogenic addiction.
    We all need to fight back and have our voices heard because we the victims and survivors are the REAL EXPERTS by experience.
    Take care,

    Barry Haslam.
    Benzodiazepine drug survivor and campaigner.

    • Hi Barry,
      Its good to see your hard work paying off, I agree with everything you say here.

      There’s been plenty of research conducted on the major tranquillisers and dependency (compensatory brain structure changes), stretching back to the 1960s – but it’s been swept under the carpet.

      The best way to withdraw from these drugs according to Irish member of ‘parliament’ Sean Fleming is “S L O W L Y”.

      • Hi Fiachra,
        The British Medical Association are actually talking about ‘”taking action” on this issue which is a first. We have had masses of evidence over decades on the dangers of these drugs, certainly benzodiazepines and lots of false promises and empty words. So to finally hear “taking action ” is music to my ears after all this time of campaigning. It will not come overnight but it will be a huge step forward.

        As you rightly say, withdrawing slowly is the best and safest way to come off these drugs and this needs to be in the mind set of the rehabs and detox units. As I have witnessed in the UK, a 3 week withdrawal has left patients damaged and disabled and to unnecessary suffering. Patients need to be withdrawn at a pace which they are comfortable with.

        The tide in the UK is turning and I really hope the USA will follow suit.

        Barry.

  3. After 12 yrs of medically induced opiate addiction, I had a moment of clarity and regained a small part of my integrity and put down the drugs. Its been 130 days since my last dose of Suboxone. I am still having side effects from the withdrawal but nothing compared to what I was told would happen if I quit taking the drugs. The original pain that I was prescribed for 13 yrs ago is not that bad, a few aspirins and its manageable. I am blessed to have a supportive family and pharmacy staff. I would still probably be on the opiate train if it wasn’t for the support. There was absolutely no aid from the original Dr. the “rehab” sector or any support groups that understood the special nuances that occur when the patient is trying to do what the Dr. says. Yes, the U.S. is lagging far bhind the U.K. in these matters.

  4. Bigfish,
    Well done for your withdrawal from Suboxone and for having a supportive family, because I know that it helps enormously when battling through withdrawal. I too was one of the lucky ones in this respect.

    I withdrew myself from benzodiazepines and opiate painkillers at the same time over a 15 month period and it was the best and hardest thing, that I have ever done in my life.

    Good luck for the future and well done again.

    Barry.

  5. “The report acknowledges a noticeable difference of opinion about that causes of prescription drug dependence between the governmental and practitioner organizations on one side and the support groups, withdrawal charities, and affected individuals on the other. The first group attributed patterns of dependence to individual differences in patients while the latter placed accountability on the inappropriate prescribing practices of the doctors.”

    That is in itself very telling. Let me translate:

    “first group attributed patterns of dependence to individual differences in patients” -> “these people are junkies and their defective brains are to blame”

    But it’s nice that some people are starting to address the problem. It is too little, too late for many but maybe it will help at least some and prevent more people from getting hooked on these drugs going forward.